HomeMy WebLinkAbout3532-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
THIS CERTIFIES that the building located atl~.$~?.~.e~.. A?.$ ............. Street
~ .Fairviev Pa~k . . ..........
ap ~o ........... ]~roc~: No ............. Lot No.l~l ....~BI...~.~..1.~.~
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ....... ~T~lla.. ~. ..... , 19.67. l~Ursuant to which Building Permit No..
dated ......... J~ill~ .... ~1)- -, 19.6?', was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .. Pl'~,~&tll..olle. ~i~. &~l,:l.:J~g .....................................
The certificate is issued to . .,T.~.e.~ ~ ~l~ffO~ .... ~Nl~e~ ...........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . $~l~t. I~.~ .1~...1~..I~.
Building Inspector J
FORM NO, 2
TOWN OF SOUTHOLD
BUILDING DEPAitTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 3532 Z
Dete .......................... ~.....,~.0. .......... , 19...0~
Permission is hereby granted to:
...... i.. ....... ~...$.~ ...............................................
.............. ~.;....~u,t,,haZ~. .......................................
to '. ~,.~,.:~r~l~ ..~;. ,~.~,~ ....~W~L~ ~ ............................................................. ., ....................
...... ;.....~ ............ : .......... .,. ......... ;...~;..~ ........................................................................... ~ ...... ~ .....................
at premises located ,~t ...T~.~.**,l,~.****;l~;[~le~..~.~.'k .................... : ......................... ~ .......................
.. i.......,....]~t.~ ..(~lee~,~'a~.'.~ze...'. ...... ;. ~t~o;IA. ........................................................................
~ursuon~' to application doted. ....... :. ............... ~T~,~....,~,~ ................. , 19~f",, and'approved by the
Building InsPector, .~ .
Building Inspector
S-9
SCHD
SUFFOLK COUNTY DEPARTHENT OF HEALTH
~ld~. Permit No. c7~-J~.7-
TO WHOM IT MAY CONCERN:
The sewage disposal facilities for a structure located
(Give deed location) /
have been inspected by this department and found to be satisfactory.
./r~.~'-?~ ~-o'7 TOWN OF SOUTHOLD PROPERTY RECORD CARD
)WNER STREET VILLAGE DIST. SUB, LOT
:ORMER O,WNER ,Krl ob~ k N E ! '
~.~/~ !SEAS. VL ~ FARM COMM. CB. MISC. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
" / ¢ u'
:ARM X~re Value Per V~lue ' ¢)Y~r ~'~ '
liable 3
'oodland
¢ampland FRONTAGE ON WATER
ushlond FRONTAGE ON ROAD
~use Plot DEPTH
~ ~ ~ ~ BULKH~D
~ /
~ DOCK
~tal ~' '~ ~ , , .
COLOR
TRI,M
Extension
Extension
Extension
),~mdation
Basement
Ext. Walls
Fire Place
Bath
Floors
Interior Finish
Heat
Type Roof Rooms 1st Floor
Porch Recreation Roorr Rooms 2nd FIoo
t~h'~J),eJ(, /~4/'22. ~7~ .2--( ~c~,, Dormer
Breezeway Driveway
Garage
Total
Dinette
¸LR.
i DR.
FiN. B.
FOBM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
E om, ed ....:.:,. .............
Approved ......~:.~ ........................ .~.~....., 19 ........ Permit No.
D,sopproved..- ........
........... , .............. ('~';,';i;i;;,'~"i;;~;;';;>i .................................
Application No. ''~ .....
APPLICATION FOR BUILDIN,G.?ERMIT
~ot~--: t...~:: ~.:.~... ~:.. './.. ......................
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to ad oining premi.ses or public streets or
areas, and giving o detailed description of ayout of property must be drawn on the diagram which is part of this application.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the progress of the work.
e. No building shah be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of So~thold, Suffolk County, New YQrk, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or emolition, as herein described.
The applicant agrees to comply with all applicable laws, building code and
or name, if a corporation)
State whether applicant i~s owner,,lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder.
~; z.~ /:2 /.~.::
,~ame or owner o p ::7 ................. ,'. ............. : ...... :? ............, ..............................................................................
' ~ r
tf applic~6 a corporo~, s~gnotufe of duly~outhonzed office .
(~ome ~nd titlo of corporote
-.~/ ~ /~
1. Location of and on wh ch proposed work wi l be done M~p No ~~~</~t No'
- 'e '":,Z ..........................
Street and INureD r .... (..w~~ ..... ':,,.,,% ................ ~ .......... ~ ........................................
Municipality
2. State existing use and occupancy of premis~z//~ ~and intended,use and occupancy of proposed construction:
a ~x,,~se~.do~p~c, ~*::~.~.~ . . .............................
b. Intended use and occupancy ....... ~:f~ ...................................................................................
3. Not, ire of work (check which applicable): New Building Y Addition Alteration
Rep~ lir .................. Remo_~.al .......... ~ Demolition ................ .~t~er Work (Describe)
4. Estir~area k. ost ............................................................ tee
(to be paid on filing this application)
5. If d~velling, number of dwelling units ...... ~....Number of dwelling units on each floor
If go, rage, number of cars ........... '.
1
6. If I:jusiness, commercial or mixed occupancy, specify nature and extent of each type of use
7. Dimensions of existing structures, if any: Frbnt ............................ Rear ................................ Depth
Hei~lht ........................ Number of Stories
Dim,bnsions of same structure with a.lterations or additions: Front .................................... Rear
Depth ................................ Height ...................... .~...,~umber of Stories ................................
8. Dim~ens~n~ofj ~ entire new construction: Front~ 'k.-4c..~'""~"'""d~'" ...................... Rear ..~......~... ................ Depth~..~, ..............
He ~ht ............... .7~::~:~ber of Star,es
9. SizeJof. lot: Front ....... 7~.,~.~:'...~... Rear ....~.....d~'....~.. ...................... Depth
10. Dat~ of Purchase ..................(. .................................. ~:.j~_N~.~e~f Former Owner
1 ]. Zon~b or use district in which premises are situated ........................................ ~.~. .............
n I i
12. Dae~ proposed construction, violate any .~on'~j~wlaw,~rdina ce or rec~u at'on ....................
-- . . ~;~'~'~' (:~Z-7~_d' . ,, /~
13. Na~e of Owner at pre ~r~.~ses ................. ,~,,~c ........ r. ....... ~aaress ........ ~....~ ............................. Phone No.
NaCe of.-Architect. ...~'-/,' ....... -~'.'" "~:'~' "/-'; ' '~)C.~.-~,r,-'~ ~z,/~/~.~ ........... -,,Address ~~ ............ Phone No.
Nar~e of ~.onTracror .................................................... ,'~aaress ............................................ Phone No.
/
PLOT DIAGRAM
/
L.ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr
property lines.'~' Give street and block number or description according to deed, and show street names and
whether nterior or corner lot.
STATE OF~ NEW YORK, 'L c c ~
................. [.....~.~'.?.! .......................... being duly sworn, deposes end says th.o¢ he is the
I'(Name of individual signing application)
above nar~ed. He is the
/
(Contractor, agent, corporate officer, etc.)
of said ortner or owners, and is duly authorized to perform or have performed the said work and to make and
this application; that all statements contained in this application are true to the best of his and belief;
that the w )rk will be performed in the manner set forth Jn the application filed therewith.
Sworn to b .~fore me this
· I~AR[ A. T '
........ ..... day of ........ ...... :
,~"%,~ -, !~' /'"- ,L,,,J ,l~o. 5.2.3233120 Suffo.lJ~.~.u.n~ ...................................... .~
Notary Pt )lic, ~.~'.[~.....~.~...~x~irEc~frr~y~]0' ~ (Signature of applicant)
FOI~M NO. 1
'['OWN OF SOUTHOI~D
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
APPLICATION FOR BUILDI~G~PERMIT
T
te~ ~!~'" ' '~' / ~*~' ' '~' 2~' ' ........................... '
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the progress of the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordina,~es, building code and~gulations./z
(Sig~4ature of appJicagt, or name if a corporation)
..... ........................
State whether applicant is ownm
agent, architect, engi.neer, general contractor, electrician, plumber or builder.
Name of owner of premises
If applic
a gna of dul~ officer.
..... (Name and title of corporate officer)
Location of land on which prol)~sed work w be done Map N :~.~.~.?.'?'?'?'?'?'?'?'~.~..~':.~..,~ot No' ./..~-
. .......................
Street and Number ,,.~,~ ......................................... .~,....~-,,,,,r,.,,... ........................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a, Ex~stmg use and occupancy ..........................~¢ ................................................................................................
b. Intended use and occupancy
/
3. NatJ~re of work (check which applicable): New Building .... ~¢~........... Addition .................. Alteration
RepgJr .................. Removal .................. Demolition .................. Other Work (Describe)
(to be paid on filing this application)
5. If cwelling, number of dwelling units ....... ~..~(~,...Number of dwelling units on each floor
If garage, number of cars r
6. if I~usiness, commercial or mixed occupancy,,' specify nature and extent of each type of use
7. Din ensions of existing structures, if any: Front ............................ Rear ................................ Depth
Hei ht ........................ Number of Stories
Dir~ensions of same structure with alterations or additions: Front .................................... Rear
De~c th ................................ Height ............................ Number of Stories ................................
8. Din ensions of entire new construction: Front ..... ~.~...~.~..'. ................... Rear ...Z~...~ ................. Depth-~.(~ ...........
Hei iht . ./../~.~. ........... Number of Stories
10. Dot of Purchase ...... ../.~.~..~..~.. ................................ Name of Former Owner ....................
11. Zore or use district in which/~remises are situated ...~....~C~ ............................................."."".?
12. Doe; proposed construction ~violate any zonino, law, ordinance or regulotionP .~.~ ..............
PLOT DIAGRAM
Locat clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions fr,
property li~nes. Give street and block number or description according to deed, and show street names and indic~
whether in~enori or corner Jot.
STATE OFj NEW YORK,
COUNTY .OF ...... ;;~ ....................
,(Name--~~------ot inaJvidual signing application)
above nar~ed. He is the
j (Contractor, agent, corporate officer, etc.)
of said oW.:ner or owners, and is duly authorized to perform or have performed the said work and to make o.nd
this ctpplic'ation; that all statements contained in this application are true to the best of his knowledge and belief;
that the w~)rk will be performed in the manner set forth in the application filed therewith.
Sworn to bl~fore me this
......... .~.~ ....... day of
duly sworn, deposes and says that he is the applic
Notary P~ (Signature applicant)